Chronic renal failure is incredibly complex and difficult to manage correctly – don’t just look at that next set of bloods with a high creatinine and ignore it if it’s been there before. In fact, a great deal of early renal failure will continue to progress, and predicting which patients are going to head towards end stage renal failure is especially important. We’ve seen it before with GFR and albumin-creatinine ratio – now let’s add a new marker into the mix.
As you guys know, creatinine is an easy way to look at renal failure when it becomes moderate to severe, but easily misses the mild cases. More and more of medicine is about looking at preventing the potential cases and reversing early damage, so it’s critical we find these patients with mild disease.
This is where cystatin C comes in. Cystatin C is a protein that also gets excreted by the kidney but is much more precise than creatinine. If you combine that, the ACR, and GFR measurements, you’re going to get a great prediction model – which is what we see in JAMA this month.
Looking at over 25,000 patients, adding cystatin C increased the accuracy of predicting renal failure. This may become the standard in future, an addition to the regular urea and electrolytes panel (presuming the test is affordable), and make the management of chronic kidney disease a whole new ball game.
Check it out here.
IMAGE Ed Uthman